| NPI | 1568694610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: LA 1168) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: MS MRT4610) |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2013-08-20 |